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Lymphocytic Colitis

By MMI board-certified, academically affiliated clinician

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May 18, 2018

Lymphocytic colitis is a health problem that causes inflammation of your large intestine. It causes episodes of long-term (chronic) watery diarrhea and belly pain.

Your large intestine is part of your digestive (gastrointestinal or GI) tract. Your GI tract includes both the colon and rectum. It goes from your mouth all the way to your rectal opening. The large intestine gets the broken-down products of food from the small intestine. One of its main jobs is to reabsorb water and electrolytes, such as salt. The colon leads to the rectum. The rectum stores your feces before your body expels them.

In lymphocytic colitis, inflammatory cells from your immune system travel to your large intestine. Here they cause swelling and inflammation of the tissues. Immune cells (lymphocytes) may build up in the area as well. The inflammation may keep your large intestine from reabsorbing as much water as it should. This leads to diarrhea, belly pain, and other symptoms.

Lymphocytic colitis is one type of inflammatory bowel disease (IBD). IBD is group of conditions that cause inflammation in either the small or large intestine. Lymphocytic colitis is a type of microscopic colitis. Microscopic colitis is inflammation of the large intestine that can only be seen through a microscope. The other main type of microscopic colitis is collagenous colitis. Some experts think lymphocytic colitis and collagenous colitis might be the same illness presented in different ways.

Lymphocytic colitis is not common. It’s more common in older adults, but it can affect younger adults and children. It’s also more common in women than in men.

Experts are trying to understand what causes the inflammation of the large intestine that leads to lymphocytic colitis. Some people think that something in the GI tract triggers this abnormal immune response. This might be bacteria, pollen, or food.

Taking certain medicines may also trigger the condition in some people. These medicines can include:

Nonsteroidal anti-inflammatory drugs (NSAIDs). These can include aspirin or ibuprofen.

Acid reflux medicines

High cholesterol medicines

Diabetes medicines

Medicines to treat depression

Certain bacteria may trigger lymphocytic colitis in some people. You might have your first episode after getting sick from bacteria. These can include Campylobacter jejuni or Clostridium difficile. Toxins in these bacteria may harm the inner surface of your large intestine. This can cause inflammation. Some experts think certain viruses may also play a role in lymphocytic colitis.

Some foods trigger the condition in some people. Certain foods may also make lymphocytic colitis symptoms worse. These can include caffeine, artificial sweeteners, and milk products.

Having certain health issues may increase your risk for the disease. These include:

Diabetes

Celiac disease

Irritable bowel syndrome

Being a smoker may increase your risk for the issue. Smoking interferes with the blood flow that your intestines need. Your risk for lymphocytic colitis may also be higher if someone in your family has the condition or another inflammatory bowel disease.

The main symptom of lymphocytic colitis is chronic, watery diarrhea. This diarrhea does not have blood. You may have several of these watery bowel movements each day. This may last for weeks or months. For most people, this diarrhea goes away for a while, but then it comes back later.

Other symptoms of lymphocytic colitis may include:

Weight loss

Belly pain

Bloating

Dehydration

Nausea

Fatigue or weakness

Joint pain

Not being able to control a bowel movement

You may need to see a gastroenterologist. This is a doctor with special training to treat problems of the digestive tract.

Your healthcare provider will ask you about your health history and your symptoms. Your healthcare provider will give you an exam, including an exam of your belly (abdomen).

Your healthcare provider will rule out other causes of your diarrhea. These can include an infection or another inflammatory bowel disease.

Your healthcare provider will also do other tests. These may include:

Blood tests, to check for anemia and infection

Tests for celiac disease

Stool analysis, to check for inflammation or infection

Imaging tests of the intestines. These include a CT scan, MRI, or an upper GI series.

You may also need a colonoscopy. This test looks at the lining of your colon and rectum. It uses a light and a tiny camera.

The colon often looks normal on a colonoscopy. During the colonoscopy, your healthcare provider can take out tissue samples of your colon. Then he or she will look at it under a microscope to tell if you have lymphocytic colitis.

Medicines

Your healthcare provider may give you antidiarrheal medicines. You may also need a medicine (mesalamine) to reduce inflammation. Or you may need a medicine (cholestyramine) that stops bile acids if you still have symptoms.

If the medicines you take make your symptoms worse, your healthcare provider may stop your treatment with those medicines.

Most people respond well to medicines. But relapses may happen. If your symptoms come back often, you might need to start taking certain medicines on a long-term basis.

Changing your diet

You may need to avoid foods that make your diarrhea worse. These may include dairy products, caffeine, artificial sweeteners, and foods high in fat. Some people with this condition also do well on a gluten-free diet. It's also important to drink plenty of fluids to prevent dehydration.

If you don’t respond well to treatment, your healthcare provider may look for other possible causes of your symptoms.

Unlike other forms of inflammatory bowel disease, lymphocytic colitis doesn’t seem to increase your risk for colon cancer. It does not increase your risk of death from any cause.